Psychotherapy For Patients Research Articles

Silence after narratives by patients in psychodynamic psychotherapy: a conversation analytic study

Silence after narratives by patients in psychodynamic psychotherapy: a conversation analytic study

Global Change in Psychotherapy: Influences of Current Social Change on Mental Health and Therapy

Global change affects both individual life situations and social coexistence in a variety of ways. However, the effects of social events on mental illness and psychotherapy are only recorded and included in psychotherapy research in individual areas. The aim of this study is to explore current problems and concerns of patients in Germany on the basis of practical experience reports, to collect possible social causes and to bundle considerations for therapeutic treatment. To this end, psychotherapists (n=10) and psychotherapy patients (n=12) were interviewed in qualitative interviews and these were analyzed using grounded theory. After evaluating the collected perspectives, five main effects of current social events and the consequences of globalization were identified. From the perspectives of psychotherapists and patients, these include increasing anxiety about the future, decreasing social inclusion, increased questions about goals and identity as a concern for psychotherapy, increased psychological stress as a result of political divide and an increased demand for diversity-sensitive psychotherapy. In addition to expanding the scope of action, therapeutic approaches primarily include providing contact, guidance, orientation, emotional support and bonding experiences. The inclusion of knowledge from psychotherapists and patients as well as findings from social science can be helpful for identifying current problems and developing new therapeutic approaches or bundling, linking, and effectively using existing ones.

Understanding the Patient's Rigid Patterns in Psychotherapy From the Perspective of Compensation under Classical Conditioning

It is common in psychotherapy to get bogged down in treatment progress because of patients' rigid patterns, and the first step to better dealing with this problem is to understand rigid patterns better. Therefore, it is essential to start with the concept of compensation under classical conditioning to help understand the rigid pattern of patients in psychotherapy. Given that the understanding from this perspective is relatively new and largely fragmented, it is theoretically important to evaluate what is being studied and gain meaningful insights through a structural review of the literature. After reviewing the extensive literature, this study also made some feasible suggestions on how to better understand and deal with patients' rigid patterns to assist therapists in dealing with such issues, combining the approaches taken by different schools of psychotherapy. This article is believed can provide a useful basis of understanding for future psychotherapists to better deal with patients' rigid patterns in practice.

A Novel Approach to Personalized Personality Assessment with the Attachment-Caregiving Questionnaire: First Evidence in Favor of Interpretation-Oriented Inventory Designs

In clinical psychology and psychiatry, personality is usually assessed using questionnaires developed through factor analysis (FA). Essential domains are identified, which correspond to questions/items defining a (sub)scale, and each question is rigidly assigned to one scale, giving the item the same meaning regardless of how the respondent may interpret it. However, this rigidity might hinder the instrument’s assessment capability. We tested this hypothesis using the Attachment-Caregiving Questionnaire (ACQ), a clinical and personality self-report that—through extra-scale information—allows the clinician to infer the possible different meanings that the subjects attribute to the items. Considering four psychotherapy patients, we compared the scoring of their ACQs provided by expert clinicians to the detailed information gained from therapy and the patients. Our results indicated that questions could be interpreted differently—receiving the same score for different (clinically relevant) reasons—potentially impacting personality assessment and clinical decision-making. Moreover, accounting for multiple interpretations requires a specific questionnaire design. Overall, our analysis suggests that a meaning-sensitive, personalized read of a personality self-report may improve profiling and treatment, implying the necessity of more advanced pattern recognition than the one produced by FA or similarly rigid methods, which artificial intelligence may provide. More evidence is required to support these preliminary findings.

Reflection on the RANZCP position on the adverse effects of psychotherapy.

In this perspective, we investigate how the Royal Australian and New Zealand College of Psychiatrists' (RANZCP) position statement on psychotherapy takes the potential for adverse effects into account. Psychotherapy has two critical outcomes - efficacy and adverse effects. Evidence-based psychotherapy is significantly more effective than care-as-usual for about one in 10 psychotherapy patients. However, a similar proportion also reports adverse effects. Despite this, the RANZCP position statement on psychotherapy focuses on efficacy with minimal discussion of the adverse effects. This is an oversight because psychiatrists have legal and ethical obligations to consider the adverse effects as well as the benefits of any treatment. We therefore reflect on the RANZCP's six recommendations in light of the adverse effects of psychotherapy.

Inkblots, Psychotherapy and the Tavistock Clinic

AbstractThe purpose of this article is to recount the early history of the Rorschach's inkblots test in Europe and the USA; its subsequent application in highlighting the ill effects on children of bombing during the Second World War; its wartime use in selecting military personnel; its post‐war use in selecting patients for psychotherapy at the Tavistock Clinic in London and subsequent decline in this use of Rorschach's inkblots in favour of focus on the psychotherapy patient's transference experience of the psychotherapist treating them. The article ends with evidence of interest, beyond psychotherapy, in Rorschach's inkblots and with the implications of this for the author's principal conclusion regarding the value of these inkblots in evoking the free association and conversation crucial to psychotherapy.

Patients' perspective on the therapeutic relationship and session quality: the central role of alliance.

In this study, we examined how four components of the therapeutic relationship-working alliance, real relationship, and positive and negative affective reactions of the patient toward their therapist-relate to each other and to the psychotherapy session outcome, from the patient's point of view. Our simple comprised 700 adult patients in individual psychotherapy who were recruited and participated online. They underwent a baseline evaluation of their most recent therapy session, which encompassed a series of validated self-report measures focused on specific elements of the therapeutic relationship. The results revealed that, from the patient's perspective, working alliance, real relationship, and positive affective reactions toward the therapist were positively correlated with session outcome, while negative affective reactions were negatively correlated. All components predicted session outcome when simultaneously included in a regression model. Collectively, these four components accounted for 30% of the variance in session outcome. Factor analysis revealed four distinct factors, underlying perceptions of the therapeutic relationship. Notably, the bond dimension of the alliance was sufficiently different from the task and goal dimensions, warranting consideration as a distinct construct. These findings, although cross-sectional, lay the groundwork for a more nuanced investigation of multiple dimensions of the therapeutic relationship.

The Brief Symptom Inventory in the Swiss general population: Presentation of norm scores and predictors of psychological distress.

Psychological distress is an important and frequent health problem. The Brief Symptom Inventory (BSI) allows screening for psychological distress in clinical, general and research populations. We aimed to provide normative data for the BSI and the BSI-18 for the Swiss general population: We 1) present psychometric properties, 2) develop a Swiss T-standardization and validate it using a clinical sample, 3) describe psychological distress in the Swiss general population and the clinical sample, and 4) compare the means and T-standardized scores of the Swiss general population to different German norm populations. Using a cross-sectional study design, we invited a representative sample of the Swiss general population aged 18-75 years to the study. A sample of psychotherapy outpatients had competed the BSI before start of their therapy. We calculated scores for the nine scales of the BSI (three of them constitute the BSI-18), the T-standardization and the following BSI indices: Global Severity Index (GSI), Positive Symptom Total (PST), Positive Symptom Distress Index (PSDI), and Caseness (reaching T≥63 on the GSI or T≥63 on at least two of the scales). A total of 1238 general population participants completed the BSI (41.8% male; mean age 48.9 years). The BSI had good psychometric properties. The Swiss T-standardization showed good validity when applied in the clinical sample. Females reached a significantly higher GSI score than males (p<0.001). Older participants (p = 0.026), those with higher education (p <0.001), and those employed or retired (p<0.001) reached lower scores than participants aged 18-25 years, those with compulsory schooling, and unemployed participants, respectively. A total of 18.1% (CI: 16.0-20.5) participants of the general population and 75.2% (CI: 73.7-76.7) of the psychotherapy patients were considered cases with psychological distress. Our study presents detailed normative data for the BSI and the BSI-18 based on a representative sample of the Swiss general population. This information will be helpful for clinical applications and research in the Swiss and international context.

The Impact of Mental Imagery Instructions on Patients' and Therapists' Positive Affect and Strength-Based Behaviours Within Psychotherapy Sessions: A Randomized Controlled Process Study.

Increased attention has recently been paid to the well-being and flourishing of patients in psychotherapy. This study investigated the occurrence of positive affect (PA) and strength-based behaviours within psychotherapy sessions contrasting positive versus neutral imagery instructions. This is a secondary analysis of a randomized controlled trial. Seventy-eight sessions of cognitive behavioural therapy involving 26 patients (69.23% female; Mage = 40.31) treated by 13 therapists were selected. PA and strength-based behaviours of patients and therapists were coded on a minute-by-minute basis with the Resource-Oriented Microprocess Analysis. Each session started with a brief mental imagery instruction. Data were analysed using multilevel modelling. Mild levels of PA were very common, whereas stronger expressions were occasional, especially at the beginning and end of sessions. Strength-based behaviours were employed in one-fifth of the videos analysed. Therapists in the positive imagery instruction showed more strength-based behaviours in the beginning phase of sessions, p < 0.05. The two imagery instructions significantly differed in the session trajectories of PA, p < 0.05. A quadratic trend with higher initial values and a sharper decline in PA were found in the positive instruction, whereas the neutral instruction showed a flatter trend. Patients and therapists experience PA and discuss strengths in psychotherapy sessions despite patients' distress. The positive imagery instructions potentially induced a positive focus at baseline for therapists but had a negligible effect on the subsequent session progression. ClinicalTrials.gov identifier: NCT03767101 (registered December 6, 2018).

Evaluation of symptom network density as a predictor of treatment outcome of inpatient psychotherapy

Objective: The network approach implies that the persistence of a mental disorder is rooted in a dense causal interconnection of symptoms. This study attempts to replicate and generalize previous findings in support of the assumption that higher density predicts poorer outcomes. The study examines the predictive value of network density at admission for recovery after inpatient treatment. Method: N = 1375 adult patients with various forms of mental illness were classified as recovered (28%) versus not recovered (72%) after inpatient treatment. Recovery was defined as clinically significant improvement in impairment from admission to discharge. Networks of transdiagnostic symptoms at the time of admission were estimated. Network density, measured by global strength d, was compared between the recovered and not recovered groups using a permutation test. Results: Global strength at the time of admission tended to be higher in the No-Recovery group (d = 10.83) than the Recovery group (d = 7.53) but the association was not significant (p = .12). Similar results were found after controlling for group size and symptom severity. Conclusion: The predictive value of network density for treatment outcomes remains unclear. There might be structural differences between the groups that the current measure of network density does not adequately represent.

Indication and Prevalence of Inpatient Psychosomatic-Psychotherapeutic Rehabilitation in Patients in Outpatient Psychotherapy Data from a Study on the Epidemiology of Care

Outpatient psychotherapy is qualitatively and quantitatively an important treatment option for patients with psychological disorders. Additionally, there is the option of inpatient care, including psychosomatic rehabilitation units. There is a lack of data on the cooperation between the ambulatory and the inpatient sector, and on which patients in outpatient psychotherapy have already been in psychosoamtic rehabilitation or should be admitted. 131 psychotherapists were interview with regard to 322 cases they had recently seen with focus on the ongoing treatment, previous rehabilitation-treatments and current indications for rehabilitation programs. Almost all patients were suffering from year long disorders. More than every second patient had problems at work. Together, these are core criteria for psychosomatic rehabilitation. 28% had already been in inpatient rehabilitation and another 28% were seen in need of inpatient rehabilitation. Comparison of patients who had been, were in need, or did not need such treatment showed that rehabilitation patients were older, had a lower education, were more severe ill, showed a more problematic course of treatment, had more problems with participation and needed more socio-medical support. Results suggest that psychotherapists treat many patients, who fullfilled admission criteria for inpatient rehabilitation. They are important cooperation partners of rehabilitation units. Pension and health care insurance should support cooperation. Because of the great number of patients there is also the need to sharpen the criteria for inpatient treatment.

Living the Language of Psychotherapy: How Therapists Use Their Experiences from Being Patients

Personal therapy is a requirement in several psychotherapy-training programs, and more than 80% of therapists have been psychotherapy patients. No quantitative evidence of the effects on their patients’ outcomes has been presented. However, qualitative studies and expert experiences highlight the value of therapists having been patients themselves. To investigate this further, we used in-depth qualitative methods to explore the experiences of eight early career psychologists. For our data collection, the participants wrote reflexive notes on two occasions, and met for a full day of focus groups. The notes and transcriptions of the focus groups were analyzed from the perspective of reflexive hermeneutic phenomenology. In all, the therapists had been patients in 19 courses of various psychotherapies. The core experiential themes were: (1) their own suffering had been for real; (2) ambivalence of sharing vulnerability; (3) the significance of experiencing theoretical concepts – the language of psychotherapy – in real life; (4) dealing with shame; (5) the need to know that therapists may become so important that the patient can easily be hurt; and (6) the therapist became an inner model that the patient could use. The therapists seemed to use their psychotherapy experiences in their personal development and professional lives. Therapists may have a unique opportunity to benefit from psychotherapy due to the language they have acquired for sharing experiences with their therapists.

Teilhabeorientierte Psychotherapie bei arbeitsfähigen und arbeitsunfähigen Patienten mit psychischen Erkrankungen

ZusammenfassungHintergrundDie Behandlung (chronischer) psychischer Erkrankungen zielt sowohl auf die Symptomreduktion als auch auf die Verbesserung der sozialen und beruflichen Teilhabe durch sozialmedizinische Behandlungen und Beratungen ab. Ziel der vorliegenden Studie war es, arbeitsfähige und arbeitsunfähige Psychotherapiepatienten im Hinblick auf Gemeinsamkeiten und Unterschiede des Patientenstatus und der Behandlungssituation zu vergleichen.Methoden73 kognitive Verhaltenstherapeuten und 58 psychodynamische Psychotherapeuten wurden zu 188 bzw. 134 aktuellen Patientenbehandlungen befragt. Die Fallberichte bezogen sich auf Patienten, die im Durchschnitt 42 Jahre alt waren (65 % Frauen).ErgebnisseEs gab keine Unterschiede zwischen Patienten ohne oder mit kurzer Krankschreibung (bis zu 6 Wochen, n = 156) und Patienten mit längerer Krankschreibung (7 Wochen oder mehr, n = 140) in Bezug auf grundlegende Merkmale der Behandlung (Nebenwirkungen, therapeutische Allianz). Patienten mit längerer Krankheitsdauer hatten schwerere Beeinträchtigungen der Leistungsfähigkeit und Teilhabe. Sie erhielten spezifischere, auf die Teilhabe am Arbeitsleben ausgerichtete Behandlungen, während allgemeine salutotherapeutische Aktivitäten (Sportverein, Beratung, Familienunterstützung) bei Patienten mit kürzerer oder längerer Krankheitsdauer in gleicher Weise durchgeführt wurden.DiskussionDie Therapeuten wählten die Behandlungsoptionen indikationsbezogen aus: Bei Patienten mit Problemen der Teilhabe am Arbeitsleben wurden mehr arbeitsbezogene Behandlungen durchgeführt, während Behandlungen zur Verbesserung der allgemeinen psychischen Gesundheit unabhängig von spezifischen Problemen der Teilhabe am Arbeitsleben eingesetzt wurden.

State and trait characteristics of attachment as predictors of outcome in inpatient psychotherapy.

Attachment has mostly been investigated as a stable characteristic of individuals, although theoretical considerations and recent empirical findings suggest that attachment styles are also subject to change. When attachment is investigated as a treatment factor in psychotherapy, state and trait characteristics need to be differentiated, as they warrant different conclusions. This study examined the trait- and statelike characteristics of attachment styles over the course of inpatient psychotherapy as predictors of treatment outcome. A total of N = 419 patients provided weekly measurements of attachment styles and symptoms for up to 8 weeks of inpatient psychotherapy. Data were analyzed in multilevel longitudinal models controlling for rolling admissions and weekly changes in group membership. Over the course of treatment, patients' attachment styles became more secure and less fearful-avoidant. Trait attachment security as well as gains in attachment security predicted better outcomes, while trait preoccupied and fearful-avoidant attachment as well as increases in attachment preoccupation and anxiety predicted worse outcomes. Findings imply that attachment security may grow during a relatively short inpatient treatment period and both trait attachment styles as well as changes in attachment styles predict outcome. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Personality Functioning Improvement during Psychotherapy Is Associated with an Enhanced Capacity for Affect Regulation in Dreams: A Preliminary Study.

Clinical case illustrations of patients with an impairment of personality functioning (IPF) have repeatedly reported that progress during psychotherapy is reflected by alterations in dream content. However, quantitative studies based on samples of psychotherapy patients are scarce. As a core component of both personality functioning and contemporary psychodynamic dream theory, the construct of affect regulation is of specific significance in this context. To test if improvement in personality functioning in the course of psychotherapy is associated with an increasing ability to regulate affects in dreams. In a longitudinal design, affect regulation was compared in N = 94 unsolicited dream reports from the first vs. last third of long term psychotherapy of ten patients with initial IPF. Dream reports were transcribed from recordings of the sessions. Expert ratings of the level of personality functioning were obtained using the Scales of Psychological Capacities. The capacity for affect regulation was assessed using the Zurich Dream Process Coding System. Group differences were assessed using linear mixed models, controlling for dream length as well as the nested structure of this data set. Patients demonstrated an increased capacity for affect regulation in dreams that was primarily evident in three core features: the complexity of dream elements (cf., e.g., parameter attributes, p = 0.024); the extent of affective involvement in the dream ego (cf., e.g., parameter subject feeling, p = 0.014); and the flexibility to regulate the dynamics of safety/involvement processes (p ≤ 0.001). This pattern was especially prominent in a subgroup (n = 7) of patients with more pronounced improvements in personality functioning. These findings support the hypotheses that decreasing IPF during psychotherapy is associated with increases in the capacity for affect regulation in dreams. Thus, researchers and therapists can utilize dream reports to illuminate the important aspects of treatment progress in clinical practice.

The Attachment-Caregiving Questionnaire as a Personality Inventory Sensitive to Psychological Vulnerabilities: A Pilot Study

Evolution enabled the human species to form attachment relationships, where a caregiver looks after a needy attacher. In early-life interactions with a parent-caregiver, the child-attacher acquires adaptive durable information—the attachment dimensions—which become part of their personality. As such, the dimensions affect vulnerability to psychological conditions, but the precise nature of this link remains controversial. With this pilot study, we addressed this issue. Considering a sample of 67 psychotherapy patients, we tested (H1) the expected connections between dimensions and specific vulnerability to psychological conditions and (H2) the capability of a self-report to detect such links. We relied on the Attachment-Caregiving Questionnaire (ACQ) to measure seven dimensions and test the hypotheses by (1) investigating the correlation between the patients’ dimensions and their symptoms and (2) building logistic regression models to test whether the dimensions can predict vulnerability to specific symptoms. Our analysis demonstrated that almost all expected dimensions could predict vulnerability to related symptoms. Given the limited sample size, one dimension could not be connected to any symptoms. This study provides preliminary support for the connections between attachment dimensions and vulnerability to clinical conditions and the ACQ’s capability in detecting such links. Further testing is required.

Assessing the patient's affective perception of their psychotherapist: validation of the in-Session Patient Affective Reactions Questionnaire.

Psychotherapists need effective tools to monitor changes in the patient's affective perception of the therapist and the therapeutic relationship during sessions to tailor therapeutic interventions and improve treatment outcomes. This study aims to evaluate the factor structure, reliability, and validity of the in-Session Patient Affective Reactions Questionnaire (SPARQ), a concise self-report measure designed for practical application in real-world psychotherapy settings. Validation data was gathered from (N = 700) adult patients in individual psychotherapy. These patients completed the SPARQ in conjunction with additional measures capturing sociodemographic details, characteristics of therapeutic interventions, individual personality traits, mental health symptom severity, elements of the therapeutic relationship, and session outcomes. This comprehensive approach was employed to assess the construct and criterion-related validity of the SPARQ. The SPARQ has a two-factor structure: Positive Affect (k = 4, ω total = .87) and Negative Affect (k = 4, ω total = .75). Bifactor confirmatory factor analysis (CFA) yielded the following fit indices: X2[df] = 2.53, CFI = .99; TLI = .98; RMSEA = .05; and SRMR = .02. Multi-group CFAs demonstrated measurement invariance (i) across patients who attended psychotherapy sessions in person versus in remote mode, and (ii) across patients with and without psychiatric diagnoses confirmed metric invariance. Furthermore, the SPARQ showed meaningful correlations with concurrently administered measures. The SPARQ proves to be a valuable instrument in clinical, training, and research contexts, adept at capturing patients' session-level affective responses towards their therapist and perceptions of the therapeutic alliance. Comprehensive descriptive statistics and a range of score precision indices have been reported, intended to serve as benchmarks for future research.

A Case of Traumatophilia Through Transgender Embodiment

Virginia is a White trans lesbian woman in her late 30s living in a rural environment in the United States. She is a long-term psychoanalytic psychotherapy patient in a community mental health center. She has a significant trauma history from childhood. Harnessing Avgi Saketopoulou’s concept of traumatophilia, this article analyzes Virginia’s intra and inter-psychic dynamics that result from her material experience in the world. Under a ubiquitous threat of politicized violence within her community, she experiences a constant fear for her and her family’s safety. At the same time, Virginia experiences a sexual attraction for women who have voiced anti-trans bias. In conjunction with her trauma history, this dynamic illustrates Virginia’s traumatophilia forming a tension between her experience of terror in the face of bigotry and her fantasy of inclusion. Detailing the political implications of trans experience as connected to the psychic conflicts manifested within a traumatophilia, the article concludes that trans experience is both implicitly and explicitly political. As such, psychoanalytic practitioners working with trans patients should focus on the ways in which psychic suffering is shaped and conditioned by the social world.

Development and validation of an 8-item version of the Real Relationship Inventory–Client form

Objective: To develop and validate a very brief version of the 24-item Real Relationship Inventory–Client (RRI-C) form. Method: Two independent samples of individual psychotherapy patients (Nsample 1 = 700, Nsample 2 = 434) completed the RRI-C along with other measures. Psychometric scale shortening involved exploratory factor analysis, item response theory analysis, confirmatory factor analysis (CFA), and multigroup CFA. Reliability and convergent and discriminant validity of the scale and subscales were also assessed. Results: The 8-item RRI-C (RRI-C-SF) preserves the two-factor structure: Genuineness (k = 4, α = .86) and Realism (k = 4, α = .87), which were correlated at r = .74. CFA provided the following fit indices for the bifactor model: X 2/df = 2.16, CFI = .99, TLI = .96, RMSEA = .07, and SRMR = .03. Multigroup CFA showed that the RRI-C-SF was invariant across in-person and remote session formats. The RRI-C-SF demonstrated high reliability (α = .91); high correlation with the full-length scale (r = .96); and excellent convergent and discriminant validity with measures of other elements of the therapeutic relationship, personality characteristics, current mental health state, and demographic-clinical variables. Clinical change benchmarks were calculated to serve as valuable tools for both research and clinical practice. Conclusion: The RRI-C-SF is a reliable measure that can be used for both research and clinical purposes. It enables a nuanced assessment of the genuineness and the realism dimensions of the real relationship.

Rorschach Human Movement and Psychotherapy: Relationship with the Therapist’s Emotional Responses

The emotional responses of psychotherapists to their patients, known as countertransference, can yield valuable insights into the patient’s psychological functioning. Albeit from a different perspective, the Rorschach test also provides information about the patient’s psychological processes. In particular, the Rorschach human movement response (M) has been shown to be a useful measure of higher-level psychological functioning. In an attempt to bridge these two largely different perspectives, the aim of this study was to explore the association between M responses in the Rorschach protocols of psychotherapy patients and emotional responses exhibited by their therapists. To this end, a convenience sample of 149 outpatients were administered the Rorschach according to the Comprehensive System, and their therapists completed the Therapist Response Questionnaire. Through a series of regression models, controlling for response style, response complexity, and degree of psychopathology, M demonstrated a significant association with the therapists’ emotional responses. A lower number of M responses was associated with the therapists’ feelings of disengagement, and a higher number of M responses was associated with the therapists’ feelings of being more involved with the patient. Taken together, these results suggest a potential relationship between the number of M responses the respondent gives in the Rorschach and the subsequent development of the therapeutic alliance between the respondent and their therapist.